Evidence-Based Wound Irrigation: Separating Fact from Fiction

Abstract

The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation. (Plast.

Practical Review of the Management of Animal Bites

“…17 Additionally, patients presenting 1–2 days post bite carry a 3.5 and 7 times increase in the relative risk of hospitalization or surgery, respectively compared to patients presenting the same-day. 17 All wounds, and in particular those requiring subsequent primary closure, should undergo high-pressure irrigation 19 and debridement. 16 Primary wound closure has been demonstrated to be superior for injuries in aesthetically sensitive areas such as the face as compared to healing by secondary intention.…”

“…58 Risk factors for subsequent hospitalization include smoking, immunocompromised state, location of bite over a joint or tendon sheath, and initial physical findings of erythema and swelling. 59 The initial treatment of cat bite wounds is similar to dog bites, entailing irrigation, 19 debridement, wound culture, and assessment of tetanus and rabies risk. 51,52 However, the primary closure of cat bites is not recommended due to the deep penetrative nature and increased contamination rate associated with these wounds.…”

Management of mammalian bites

“…For puncture wounds, try gently flushing with an 18 gauge cannula attached to a syringe; ensure irrigation fluid drains out. After flushing, use an antiseptic agent such as soap, povidone-iodine, or polyhexanide to help reduce infection 2730…”

Analysis of flow rate and pressure in syringe-based wound irrigation using Bernoulli's equation

“…Wound irrigation involves the use of an irrigation solution to remove foreign substances attached to the wound surface by applying a constant pressure to the surface. This reduces the bacterial load and infection rate and plays an important role in improving the wound environment and healing the wound by preventing and delaying the formation of a biofilm 7 . The Agency of Health Care Policy and Study (AHCPR) recommends an irrigation pressure of 10 pounds per square inch (psi) ~ 15 psi.…”